Connecticut Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Health Reinsurance Association of Connecticut / HRAC
Insurance Regulation Establishing Risk Pool
Connecticut Insurance Department
Connecticut Health Care Act of 1975 – Chapter 700c, Sec. 38a-556
Funding
The HRA is partially funded by the premium payments that are collected from enrolled participants. Deficits in the program are funded through an assessment of the insurance companies that operate in Connecticut, and there is not tax offset.
Plans Offered
Any health insurance company conducting business in the State of Connecticut must provide a comprehensive individual health plan available to all residents of the state, regardless of their health status. This does not apply to residents of the age of 65 or that qualify for Medicare. There are 3 types of plans available under HRA, 1) individual plans, 2) conversion plans and 3) portability plans. Each of these plans has two options, which are the Special Health Care plan (SCHP) and the United HealthCare PPO plan. A TAA qualified plan is also available on the individual and portability plans. HMO coverage is available for the conversion and portability plans.
Plan Benefits
The United Health Care PPO has $1,500 annual deductible and pays 80% of most covered medical expenses after the deductible has been met. The annual out-of-pocket maximum is $7,500 in-network and $15,000 out-of-network. A separate deductible applies to prescription drugs, after which there is a set co-payment. The Special Health Care Plan will pay 75% of the Medicare reimbursement level after the plan member meets the annual deductible. The deductible you are required to pay is based on your income level. The annual out-of-pocket maximum is $2,500. The HMO has no annual deductible, $25 office visits, a $250 (first 4 days) per day hospital co-payment and set co-payments for prescription drugs.
Maximum Benefit Limits
The maximum payable lifetime benefits per insured HRA member for all of the plan types offered is $1,000,000. Some covered benefits under the plan are subject to annual maximum benefits.
Eligibility
There are different eligibility requirements, based on the type of HRA plan for which you are applying:
Individual PPO Plan. For all plans, you must be a resident of Connecticut and between the ages of 19 and 65
Individual SCHP Plan
- Your eligibility for specific deductible options are based on your income and your family size
- Low Income plans require your income to be no more than 200% of the national poverty level
HMO Conversion Plan
- You are terminating benefits under a group plan that was issued in the State of Connecticut
- Your previous group plan was not self-funded
- Your application is received within 31 days of the termination date of your group health insurance coverage
- You were covered under your previous group health plan for at least 12 months
SCHP Conversion Plan
- You are terminating benefits under a group plan that was issued in the State of Connecticut
- Your previous group plan was not self-funded
- Your application is received within 31 days of the termination date of your group health insurance coverage
- You were covered under your previous group health plan for at least 12 months
- Your eligibility for specific deductible options are based on your income and your family size
- Low Income plans require your income to be no more than 200% of the national poverty level
HMO Portability Plan
- Must have 18 months of prior continuous heath insurance coverage with a gap of no more than 120 days (150 days if loss of insurance was due to loss of job)
- Your most recent active health insurance was through a group health plan
- Your application is received within 63 days of the termination date of your group health insurance coverage
- You are not eligible for continuation of coverage under COBRA regulations
Enrollment Periods
Enrollment, in some cases, will apply to the type of coverage you are applying for under HRA. The individual plans do not have a restriction on when you can enroll, but the conversion plans require that you submit an application within 31 days of losing your prior health insurance coverage. The Portability plans give you 63 days from loss of previous coverage to enroll.
Premium Payments
Premiums are based on your plan selection, your gender and your age.
Premium Calculations
Monthly premiums are determined by looking at the standard risk premiums available for similar plans provided by private insurers at standard risk rates. Health plans available through the HRA must be at least 125% of the standard rates at initial enrollment or may not exceed 150% of this same rate.
Pre-Existing Condition Waiting Periods
The individual plans have a 12 month exclusionary period for pre-existing conditions. This exclusionary period is waived if you are eligible for the conversion plan or the portability pan.
Health Reinsurance Association of Connecticut Contact Information
Health Reinsurance Association
100 Great Meadow Rd., Suite 704
Wethersfield, CT 06109
Phone: 800-842-0004
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